RN Case Manager | Remote

RN Case Manager Remote

Albuquerque, NM, USA Anchorage, AK, USA Austin, TX, USA Bend, OR, USA Boise, ID, USA Dallas, TX, USA Denver, CO, USA Eugene, OR, USA Fairbanks, AK, USA Houston, TX, USA Kansas, USA Las Vegas, NV, USA Oklahoma City, OK, USA Phoenix, AZ, USA Prescott, AZ, USA Reno, NV, USA Salt Lake City, UT, USA Seattle, WA, USA Tucson, AZ, USA Yakima, WA, USA Virtual Req #26794 Friday, July 12, 2024

Company Overview and Culture

EXL (NASDAQ : EXLS) is a global analytics and digital solutions company that partners with clients to improve business outcomes and unlock growth.

Bringing together deep domain expertise with robust data, powerful analytics, cloud, and AI, we create agile, scalable solutions and execute complex operations for the world’s leading corporations in industries including insurance, healthcare, banking and financial services, media, and retail, among others.

Focused on creating value from data for driving faster decision-making and transforming operating models, EXL was founded on the core values of innovation, collaboration, excellence, integrity and respect.

Headquartered in New York, our team is over 40,000 strong, with more than 50 offices spanning six continents. For information, visit .

For the past 20 years, EXL has worked as a strategic partner and won awards in its approach to helping its clients solve business challenges such as digital transformation, improving customer experience, streamlining business operations, taking products to market faster, improving corporate finance, building models to become compliant more quickly with new regulations, turning volumes of data into business opportunities, creating new channels for growth and better adapting to change.

The business operates within four business units : Insurance, Health, Analytics, and Emerging businesses.

About EXL Health

We leverage Human Ingenuity and domain expertise to help clients improve outcomes, optimize revenue and maximize profitability across the healthcare ecosystem.

Technology, data and analytics are at the heart of our solutions. We collaborate closely with clients to transform how care is delivered, managed and paid.

EXL Health combines deep domain expertise with analytic insights and technology-enabled services to transform how care is delivered, managed, and paid.

Leveraging Human Ingenuity, we collaborate with our clients to solve complex problems and enhance their performance with nimble, scalable solutions.

With data on more than 260 million lives, we work with hundreds of organizations across the healthcare ecosystem.

We help payers improve member care quality and network performance, manage population risk, and optimize revenue while decreasing administrative waste and reducing health claim expenditures.

We help Pharmacy Benefit Managers (PBMs) manage member drug benefits and reduce drug spending while maintaining quality.

We help provider organizations proactively manage risk, improve outcomes, and optimize network performance. We provide Life Sciences companies with enriched data, insights through advanced analytics and data visualization tools to get the right treatment to the right patient at the right time.

Are you a compassionate and dedicated RN looking to make a difference? Join our team as an RN Case Manager and provide comprehensive case management services for TRICARE beneficiaries with multiple or complex conditions.

You'll use your clinical knowledge, communication skills, and collaborative spirit to help our beneficiaries regain their optimum health or improve their functional capabilities.

This involves performing comprehensive assessment, care planning, implementation, monitoring, and evaluation activities via telephonic contact and digital outreach.

The goal of these activities is to help beneficiaries regain optimum health or improved functional capability, support effective self-care management, and promote access to healthcare services and community resources.

Responsibilities :

• Conduct a comprehensive assessment with beneficiaries and analyze assessment findings to identify and prioritize clinical, psychosocial, and behavioral concerns and potential gaps in care.
• Develop and document a case management care plan in direct collaboration with the beneficiary, the beneficiary's family or significant other(s), the primary physician and other health care providers.

Identify and include key concerns, needs, and preferences of the beneficiary and family / caregiver.

• Document identified issues, prioritized and individualized goals (long & short term), evidence-based interventions, collaborative approaches and resources, anticipated time frames, and barriers to achieving goals in the care plan.
• Coordinate and implement the activities specified in the care plan to provide optimal benefits coverage as well as promote continuity of care and integration of services for the beneficiary across care transitions.

Collaborate and communicate with beneficiary, family, significant other(s), physician, and other health care providers to accomplish the goals on the care plan.

Monitor and continually evaluate the care plan on a scheduled basis to ensure it remains effective and to determine if desired outcomes are met and the goals are achieved.

Revise and update the care plan as needed in collaboration with the beneficiary and the health care team.

• Initiate care conferences with Medical Director and / or the multidisciplinary care team to discuss challenging beneficiary cases and obtain expert clinical opinion or consultation.
• Serve as beneficiary advocate by promoting self-determination, informed and shared decision-making, autonomy, and self-advocacy for beneficiaries.

Empower beneficiaries by providing education and support to reinforce self-care management, facilitate access to care, and promote optimal health outcomes.

• Identify relevant benefit-related, educational, and health care resources for beneficiaries. Facilitate coordination of care with existing community-based programs and services to meet the identified needs of the beneficiary.
• Demonstrate and apply knowledge of the philosophy / principles of comprehensive case management, patient-centered, culturally sensitive care coordination, and management of complex conditions throughout the case management process.
• Collaborate with beneficiaries and their support system / caregivers, providers, the multi-disciplinary team, and health care and community resources throughout the case management process.
• Be familiar with and understand the scope of professional licensure and carry out case management activities consistent with the scope of this licensure.
• Participate in ongoing training and professional development to build and maintain case management competencies, including evidence-based practices that promote positive health outcomes and cost-effective care.
• Maintain CEUs as required by applicable State Board(s) of Nursing and required certifications. Must be willing to obtain and maintain additional licenses as required to meet business needs.
• Conduct case management activities consistently with professional standards of practice as well as all applicable policies and procedures.
• Participate in regular team conferences and meetings.
• Document appropriate clinical information and data in a timely, accurate, and concise manner consistent with applicable standards of practice.
• Maintain a working knowledge of and adhere to applicable federal and state regulations including, but not limited to, laws related to patient confidentiality, release of information, and HIPAA.

Apply knowledge of privacy and security regulations in daily practice to ensure compliance.

Qualifications

Required :

• Current, unrestricted RN license in the state of residence and ability to obtain multi-state licensure required
• Ability to obtain Security Clearance required. Current DOD Security Clearance preferred
• Associate or Bachelor’s degree in nursing from an accredited institution. Bachelor’s degree preferred
• 3+ years of clinical RN experience in direct patient care
• Knowledge of case management practices and patient-centered care concepts
• Experience as a telephonic case manager at a health plan highly desirable
• Ability to travel 25%
• Must hold United States citizenship status

Preferred :

• 2+ years of prior case management experience
• Case Management Certification highly desirable (CCM preferred)
• Experience working in an NCQA accredited case management program
• Excellent organizational and prioritization skills
• Strong communication skills (verbal, written, presentation, interpersonal)
• Ability to work independently and collaboratively
• Critical thinking and clinical problem-solving skills
• Appreciation for cultural diversity and health and digital literacy issues
• Proficiency in Microsoft Office and mobile technologies
• Professional demeanor and excellent customer service skills
• Ability to adapt to changing priorities
• Ability to work independently in a home office environment

Join us! Use your skills to make a meaningful impact on the lives of patients. We offer a supportive environment where you can thrive and grow professionally while helping others achieve better health outcomes.

What We Offer :

• EXL Health offers an exciting, fast paced, and innovative environment, which brings together a group of sharp and entrepreneurial professionals who are eager to influence business decisions.
• From your very first day, you get an opportunity to work closely with highly experienced, world class Healthcare consultants.
• You can expect to learn many aspects of businesses that our clients engage in. You will also learn effective teamwork and time-management skills - key aspects for personal and professional growth.
• We provide guidance / coaching to every employee through our mentoring program wherein every junior level employee is assigned a senior level professional as advisors.
• Sky is the limit for our team members. The unique experiences gathered at EXL Health sets the stage for further growth and development in our company and beyond.

EEO / Minorities / Females / Vets / Disabilities To view our total rewards offered click here >

Base Salary Range Disclaimer : The base salary range represents the low and high end of the EXL base salary range for this position.

Actual salaries will vary depending on factors including but not limited to : location and experience. The base salary range listed is just one component of EXL's total compensation package for employees.

Other rewards may include bonuses, as well as a Paid Time Off policy, and many region specific benefits. Please also note that the data shared through the job application will be stored and processed by EXL in accordance with the EXL Privacy Policy.

Application & Interview Impersonation Warning Purposely impersonating another individual when applying and / or participating in an interview in order to obtain employment with EXL Service Holdings, Inc.

the Company ) for yourself or for the other individual is a crime. We have implemented measures to deter and to uncover such unlawful conduct.

If the Company identifies such fraudulent conduct, it will result in, as applicable, the application being rejected, an offer (if made) being rescinded, or termination of employment as well as possible legal action against the impersonator(s).

EXL may use artificial intelligence to create insights on how your candidate information matches the requirements of the job for which you applied.

While AI may be used in the recruiting process, all final decisions in the recruiting and hiring process will be taken by the recruiting and hiring teams after considering a candidate’s full profile.

As a candidate, you can choose to opt out of this artificial intelligence screening process. Your decision to opt out will not negatively impact your opportunity for employment with EXL.

Other details

• Pay Type Salary
• Employment Indicator Regular
• Min Hiring Rate $75,
• Max Hiring Rate $95,
• Travel Required Yes
• Travel % 25
• Telecommute % 100
• Required Education Associate Degree
• Albuquerque, NM, USA
• Anchorage, AK, USA
• Austin, TX, USA
• Bend, OR, USA
• Boise, ID, USA
• Dallas, TX, USA
• Denver, CO, USA
• Eugene, OR, USA
• Fairbanks, AK, USA
• Houston, TX, USA
• Kansas, USA
• Las Vegas, NV, USA
• Oklahoma City, OK, USA
• Phoenix, AZ, USA
• Prescott, AZ, USA
• Reno, NV, USA
• Salt Lake City, UT, USA
• Seattle, WA, USA
• Tucson, AZ, USA
• Yakima, WA, USA
• Virtual
30+ days ago